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The DSM – how valid and reliable is it as a tool for diagnosis?

The DSM – how valid and reliable is it as a tool for diagnosis?. D ad P urchased M ost E xtraordinary G lasses. DSM – a multi-axial system. Axis I D isorders, clinical and mental eg schizophrenia Axis II P ersonality (underlying) including mental retardation

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The DSM – how valid and reliable is it as a tool for diagnosis?

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  1. The DSM – how valid and reliable is it as a tool for diagnosis?

  2. Dad • Purchased • Most • Extraordinary • Glasses

  3. DSM – a multi-axial system • Axis I Disorders, clinical and mental eg schizophrenia • Axis II Personality (underlying) including mental retardation • Axis III Medical and Physical conditions • Axis IV Environmental factors • Axis V Global functioning

  4. Evaluation of the DSM Strengths: • It’s the best attempt at diagnosis that there is and it allows a common diagnosis • There are studies which support its reliability and validity Weaknesses • It can be considered a way of labelling people whose behaviour we see as “different” • In the US some people argue by inventing mental illnesses psychiatrists can make more money

  5. Goldstein (1988)use for RELIABILITY • she re-diagnosed 199 patients using DSMIII, originally diagnosed using DSM–II; some differences....... But 85% consistent = Test-retest reliability • she asked two other experts to re-diagnose a random sample of 8 of the patients using the case histories with all indication of previous diagnoses removed – she found a high level of agreement/consistency of diagnosis = Inter rater reliability

  6. Stinchfield (2003) recent!!use for validity • Diagnosis of pathological gambling (severe enough habit to inhibit and interfere with daily functioning) • 803 men and women from general population of Minnesota and 259 men and women on gambling treatment programme • Questionnaire using 19 items from DSM IV criteria for pathological gambling • Questionnaire results were able to help researches to correctly sort the gamblers from the non-gamblers.- so the DSM is doing what it should .... It’s VALID!

  7. Lee (2006)recent!Use for VALIDITY and CROSS-CULTURAL • Aimed to reveal whether the DSM criteria for diagnosing ADHD would be useful for Korean children • Assessed 18 ADHD criteria in DSM IV • Questionnaire given to 48 primary school teachers. • 1663 children were rated – large sample • There was a match between the features of ADHD outlined in the DSM and the responses to the questionnaires, an ADHD test and teacher assessments • but the match was not as good for girls as it was for boys .... Maybe a validity problem

  8. Kim-Cohen et al (2005)use for validity • Longitudinal study looking at conduct disorder in over two thousand 5 year olds • Children’s mothers were interviewed and the teachers were asked to complete postal questionnaires about conduct disorder symptoms (from DSM IV) observed in last 6 months • The children who received the diagnosis were also more likely to display behavioural and educational difficulties at age 7 = Predictive validity

  9. Rosenhan (1973)use for reliability and validity • Because the diagnosis was the same across all 12 of the hospitals presumably using the current DSM at the time, we could say this shows the DSM to be reliable • Because the diagnosis of healthy people was schizophrenia, if they were using the DSM this means it lacks any validity

  10. Evaluation of validity issues STRENGTHS • The DSM has been shown to be valid across a variety of studies covering a range of different conditions • Because it is reliable it is likely to be valid too • Much work has been done to increase its validity as it has been rewritten

  11. WEAKNESSES • It is hard to diagnose people who are suffering from more than one condition (co-morbidity) when using the DSM • It can be considered to be reductionist to break down a condition into a series of symptoms, so we shouldn’t over concentrate on Axis 1 • Questionnaires and interviews such as in the Kim-Cohen study may find what they are looking for

  12. CULTURAL ISSUES and the DSM Culture does not affect diagnosis Culture does affect diagnosis Some times symptoms mean different things in different cultures eg hearing voices can make you “special” in a positive way (spiritual) There are cultural differences in symptoms Eg more auditory hallucinations in Mexico, more grandiosity in white Americans, • It’s scientific, and if we clearly define our symptoms then it can work all over the world eg Lee(2006) in Korea • Schizophrenia is more similar across cultures than different

  13. Culture Bound Syndromes • Genital retraction syndrome (Africa and Asia) • Kuru (Papua New Guinea) brain disease similar to mental illness here

  14. What should we do about the cultural problems in using the DSM? • We should be aware of the cultural • problems in diagnosis • Concentrate less on first rank (positive) symptoms which tend to be more cultural • Concentrate more on negative symptoms which are less culture-bound and easier to measure objectively

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